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Organization
VIRGINIA LICE REMOVAL, LLC
Active
Organization
VIRGINIA LICE REMOVAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERARD PHILLIP WOLBURG (CEO)
(804) 387-6509
Entity
Organization
Contact information
Practice address
1901 HUGUENOT RD STE 101, NORTH CHESTERFIELD, VA 23235-4311
(804) 337-3124
(804) 337-3124
Mailing address
12605 SOUTHWICK TER, MIDLOTHIAN, VA 23113-2848
(804) 387-6509
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/17/2017
Last updated
09/17/2017
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